Dexmedetomidine as an Adjuvant to Local Anesthetics for Postoperative Analgesia in Breast Cancer Surgery

Postoperative pain after breast cancer surgery remains an important clinical issue, particularly after mastectomy and axillary procedures.Dexmedetomidine has been studied as an adjuvant to local anesthetics with the aim of prolonging regional analgesia and reducing rescue opioid requirements.This narrative review summarizes clinical evidence from pectoral, paravertebral, serratus anterior plane, erector spinae plane, thoracic interfascial, and infiltration techniques.Most studies report longer analgesia and lower postoperative analgesic consumption when dexmedetomidine is added to a local anesthetic.However, comparison between studies is limited by differences in block technique, local anesthetic formulation, dexmedetomidine dose, and outcome assessment.Doses of 0.5-1 μg/kg have been most commonly investigated.Although the available evidence supports an adjunctive analgesic benefit, bradycardia and hypotension remain relevant safety concerns.Perineural and interfascial administration as a local anesthetic adjunct remains off-label in settings where dexmedetomidine is licensed for intravenous use.At present, dexmedetomidine appears more appropriate as a selective adjunct than as a routine component of all breast surgery analgesic protocols.